This morning, driving in, I was very puzzled. Where was all the usual rush-hour traffic? Finally I realized that most people don’t routinely come in to work on Saturday morning.
Yesterday afternoon one of the elderly patients belonging to the other half of our team became very agitated; his doctor was post-call, so my resident offered to handle the situation, which she did by promising the agitated nurses to send her medical student up to investigate. I didn’t hear that; she told me that the wife needed her hand held. So I went and took the wife down the hall to a quiet area and listened to her talk about her husband. Eventually the resident arrived, and suggested that if the patient was upset because he felt he was falling out of his chair, in spite of lying flat in bed, I should go look in his ears by way of assessing the situation. She talked to the wife, ordered some meclizine (like phenergan, supposed to help with dizziness), and went back downstairs.
This left me with the patient and nurses. The poor old man had either dementia or severe TIAs (transient ischemic attacks/ministrokes), we’re not sure which yet, and every two minutes he would start yelling that he was falling. His wife was holding his hand, and I was holding the other hand and trying to calm him down, because he was shouting loud enough to disturb the whole unit, and the nurses were not happy. The following conversation ensued:
Pt: AAAAHHH!! Push me back in the chair!
Me: You’re in the bed; here, feel it; you’re lying flat in bed.
Pt: I don’t feel like it.
Me: It’s ok, you’re in bed. . . . .
Pt: AAAAAHHH!! Push me back in the chair!
Me: You’re here in bad, you’re lying down flat.
Pt: I don’t feel like it.
[repeat ad lib]
Wife: We’ve already had this conversation.
And the nurse kept walking in and out, between trying to dispense medicines to everyone else, to observe that this didn’t look like any TIA or dementia she’d ever seen, and the wife saying he was having a seizure. Eventually they got to me, and I paged the residents until they prescribed some ativan, at which point I escaped from that floor.
When I got downstairs, all of the team was busy setting up for a thoracocentesis (needle and catheter in pleural space) for one of our sister team’s patients with a large pleural effusion. My resident had never done one, and she needed to be observed. So there was her, the intern, the chief resident, and the resident in charge of the patient, plus me. While they were setting up, I managed to absent-mindedly touch the sterile field. So I figured the safest place for me would be holding the guy’s hand.
To distract him while they were putting the lidocaine (local anesthetic), I asked where and when he had served. He had lost his leg from a battle wound in Korea. So we talked some about Korea. I felt ashamed; the only thing I know about Korea is “Frozen Chosin,” the winter retreat, and that Macarthur wanted to drop a nuclear bomb on the border with China, and Truman wouldn’t let him.
Well, the resident had to try literally a dozen times, in about six different locations, which took a whole hour; so the poor man was screaming and squeezing my hand, and my arm, and eventually I figured out he was trying to hold onto as much of me as he could reach, besides winking at me every five minutes. It took me about half an hour to realize what he was up to. And by then I figured, if he was enjoying any aspect of the proceedings, in between screaming, it wasn’t really harming me if he held my arm too. But now I know why they say to stay away from the old men in the VA.
I was not happy with the procedure, though. I had to make myself go through the whole differential diagnosis for a one-sided pleural effusion, which includes cancer and TB, to make myself not try to make them stop; not that they would have listened to me.
Well, on a different topic: one thing that I’ve learned this rotation is not to put much store in first impressions. I thought my resident would be awful, those first few days; but now I really like her. From the way she talks, you would think she would be a very rough doctor, but she isn’t. When she’s talking to patients, she’s cheerful and calm and careful, and they all like her. And then one of the other medical students, whom I haven’t known much till now; just from hearing her in class, I would think she was very brash and tough and unpleasant. But the other day (being very enthusiastic, almost a gunner) she took me along to see a man with advanced cirrhosis, and her manner with him was impressive. She was so nice, and clearly had established a good relationship with him in just a few days. Both of these women are going to be very good doctors, and their patients already love them. So I should stop jumping to conclusions.